In the current study we propose to build upon previous methods we have used in the care of acute asthma. Clinical assessments and treatment regimens are standardized using a care path as in previous studies. Demographics, height, weight, race, symptoms, signs, past medical histories, and routine medication use for the previous month prior to the index visit are recorded on an intake sheet. We routinely obtain information on disease duration, frequency of attacks, hospitalizations, ICU admissions, intubations, and a list of the general and specific triggers for acute exacerbations. We also record asthma medications including oral and inhaled steroids, short and long-acting beta-adrenergic agonists, antileukotriene drugs, anticholinergics and methylxanthines. We include in our histories all of the concurrent medications including eye drops (beta-blockers and prostaglandins), cardiac and anti-hypertensive drugs, (beta-adrenergic active agents and ACE inhibitors. We ask people how they are taking their asthma drugs, but have no way of knowing if they truly are using them as prescribed. If their medications are obtained at our hospital it may be possible to determine how many prescriptions are filled, but we still will not know use. We also record the use of illicit drugs such as cocaine, heroine, and OxyContin, etc. Body mass index (BMI) is calculated as weight in Kg divided by height in meters squared. Obesity is classified as a BMI ≥ 30 Kg/M2. Arterial oxygen saturation is determined by pulse oximetry on room air and supplemental oxygen is administered as necessary for values less than 90%. Before treatment, the best of three peak expiratory flow rates (PEFR) is taken as representing the patient's initial state of flow limitation. The PEFR data is recorded in absolute terms as well as a percentage of predicted normal. As in previous studies, if a patient's airway obstruction prevented him or her from achieving the minimum level on the peak flow meter, a value of 10 is arbitrarily assigned to avoid dividing by zero when the percentage improvement following albuterol is calculated.